Introduction to the Medical Billing Cycle Chapter One lecture 3 OT 232 1 Introduction to the Medical Billing Cycle Chapter One lecture 3 OT 232
1.8 The Medical Billing Cycle 1-21 A medical insurance specialist is a staff member who handles billing, checks insurance, and processes payments To complete their duties, medical insurance specialists follow a 10-step medical billing cycle This cycle is a series of steps that leads to maximum, appropriate, timely payment
1.8 The Medical Billing Cycle (Continued) 1-22 Step 1 – Preregister patients Step 2 – Establish financial responsibility for visits Who is primary payer? Step 3 – Check in patients Step 4 – Check out patients A medical coder is a staff member with specialized training who handles diagnostic and procedural coding The patient’s primary illness is assigned a diagnosis code
1.8 The Medical Billing Cycle (Continued) 1-23 Step 4 – Check out patients (continued) Each procedure the physician performs is assigned a procedure code Transactions are entered in a patient ledger—a record of a patient’s financial transactions Step 5 – Review coding compliance Compliance means actions that satisfy official requirements Step 6 – Check billing compliance Step 7 – Prepare and transmit claims
1.8 The Medical Billing Cycle (Continued) 1-24 Step 8 – Monitor payer adjudication Accounts receivable (A/R) is the monies owed to a medical practice Adjudication is the process of examining claims and determining benefits Step 9 – Generate patient statements Step 10 – Follow up patient payments and handle collections A practice management program (PMP) is business software that organizes and stores a medical practice’s financial information
1.9 Working Successfully 1-25 Professionalism is acting for the good of the public and the medical practice Medical ethics are standards of behavior requiring truthfulness, honesty, and integrity Thinking it Through, page 29 Etiquette is comprised of the standards of professional behavior
1.10 Moving Ahead 1-26 Certification is the recognition of a superior level of skill by an official organization Provides evidence to prospective employers that the applicant has demonstrated a superior level of skill on a national test